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1183.e2 Urinary Catheterization

Urinary Catheterization
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• Male dog
Difficulty level: ♦
○ Bandage scissors (to cut sterile wrapper finger cranially, keeping your wrist and arm
in a straight line.
Synonyms on red rubber catheter) ○ Alternatively, a vaginal speculum can be
Urethral catheterization, catheterization • Male (sedated) cat used to visualize the urethral orifice.
○ 1-inch, white adhesive tape • The urethral opening lies on ventral midline
Overview and Goal ○ 2-0 or 3-0 nylon suture for indwelling in the cranial aspect of the vestibule. There
Passage of a sterile catheter through the urethra catheter is often a papilla that lies over the urethral
into the urinary bladder to obtain a sterile urine opening that can be felt.
sample or facilitate bladder emptying Anticipated Time • After the opening is identified, remove and
• Less than 20 minutes, including the setup, then reinsert finger using the same technique,
Indications assuming an uncomplicated placement except this time with the catheter held on the
• To obtain a urine sample for analysis and • Sample collection for male dogs takes only palmar surface of your index finger. After the
culture a few minutes. opening is palpated again, use your fingertip
• To allow quantification of urinary output to guide the catheter ventrally through the
over time, or assess residual volume after Preparation: Important urethral opening. Use the nondominant
voiding Checkpoints hand to advance the catheter, maintain-
• To collect all urine over a period for specific • Review the urogenital anatomy and proper ing sterile technique. There should be no
analysis (e.g., quantification of metabolites) patient positioning. palpable resistance when advancing the
• For convenience in hospitalized animals • Perform a thorough physical exam, including catheter.
where the urine poses a threat of contagion rectal, preputial, or vaginal exam to identify • Advance until urine is flowing from the
(e.g., leptospirosis) or is causing urine scald masses, stones, or pain that can impede catheter. Verify placement by palpating
(e.g., incontinent animal) catheter placement. the tissue of the urethral papilla over the
• To relieve an overly distended bladder due to • Inspect the catheter, and verify patency of catheter.
a functional or mechanical urinary outflow the Foley balloon before use. • Collect sterile urine samples as necessary.
obstruction • After confirmed placement in the urinary
• To obtain a sample for cytologic analysis (e.g., Possible Complications and bladder, inflate the Foley catheter, gently pull
tumor identification by diagnostic traumatic Common Errors to Avoid the catheter caudally to position its tip at the
catheterization) • Avoid passing the catheter into the clitoral neck of the bladder, and connect the closed
fossa or vagina of a female. sterile collection system (if applicable).
Contraindications • Complications include development of a • Secure the catheter to the rear leg or tail to
• Preputial/vulvar mass (relative contraindica- urinary tract infection (UTI) secondary to prevent pulling or excessive traction, and
tion) contamination during the catheter placement place Elizabethan collar.
• If renal transplantation is to be performed or an ascending infection from or through Male dog:
the indwelling catheter. Make efforts to • Place dog in lateral recumbency, and an
Equipment, Anesthesia handle the catheter in an aseptic fashion. assistant elevates the “up” leg to retract the
Some supply needs differ for males or females, • Risk of urethral trauma or tear or bladder prepuce and expose the penis. The assistant
dogs or cats perforation during placement if not done pulls back the prepuce while pushing the
• Mild sedation may be necessary (especially properly (forceful or excessive advancement) penis forward from the base.
for cats, female dogs) or if there is pathology and the tissue is • Once extruded, the penis is gently cleaned
• Sterile lubricant friable. with 0.05% chlorhexidine solution.
• 0.05% dilute chlorhexidine solution • Keeping the catheter within the sterile
• Sterile syringe for pulling back urine Procedure packaging, cut and remove the end of the
(5-60 mL) Female dog: packaging (exposing the rounded tip of the
• ± Sterile gloves (females) • Sedation typically required catheter, but do not contaminate end). Then
• ± Collection tubes for urinalysis, culture, or • Place dog in sternal or lateral recumbency cut a 1-inch-wide “tab” closest to the end of
other specific needs on table (operator preference). If lateral the catheter. The tab will be used to guide the
• Catheter: generally a 5 Fr for small dogs, recumbency and right-handed operator, dog catheter into the urethra while maintaining
8 Fr for medium dogs, and 10-12 Fr for should be in right lateral recumbency with sterile technique.
large dogs; for cats, a 3.5 or 5 Fr perineal region 1-2 inches from the edge of • Apply sterile lubricant to the tip of the
○ Red rubber (sample collection, or indwell- the table. If in sternal recumbency, the pelvic catheter.
ing for cats) limbs should be hanging over the table and • The tab is used to hold the catheter as it is
○ Foley (indwelling for dogs or female cats) the tail taped or secured to the top or side being introduced into the urethra.
○ Polypropylene catheter (tomcat catheter) of the dog. • The catheter should advance easily. There may
or Slippery Sam urethral catheter (cats) • Clip, clean, and aseptically prepare the be mild resistance felt as it courses around
• If indwelling catheter perivulvar area, and flush the vestibule with the ischial arch or prostate.
○ Sterile closed urinary collection system 0.05% chlorhexidine solution. Female cat:
(fluid bag and fluid line; clamps on the • Wash hands, put on sterile gloves, open the • Sedation required
fluid line removed to ensure unobstructed Foley catheter, and apply sterile lubricant to • Digital palpation and visualization difficult
urine flow) the tip of the catheter and finger. to impossible due to small size; luckily, the
○ Sterile saline for inflation of Foley catheter • Digitally palpate the urethral opening catheter tends to blindly advance into the
○ Elizabethan collar without the catheter in hand. After inserting urethra rather than the vagina.
• Female (sedated) dog your finger, aim dorsally toward the anus • Preparation and placement otherwise the
○ Elevated table (to avoid the clitoral fossa) until the finger same as for the female dogs, using a 3.5- or
○ ± Vaginal speculum and light source passes over the pelvic brim, and then direct 5-Fr catheter.
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